Latino Perceptions of and Barriers to Healthcare in the Southwest United States

Purpose: Between the 1990 and 2000 Censuses, the Latino population accounted for 40% of the increase in the nation's total population. The growing population of Latinos underscores the importance for understanding factors that influence whether and how Latinos take care of their health. According to the Human Health Service's Office of Minority Health, Latinos are at greater risk for health disparities. Factors such as lack of health insurance, access to preventive care, physician interaction, self-perceived health status, and socio-cultural beliefs and traditions play a major role in limiting Latino use of primary healthcare (Institute of Medicine, 2005; Rojas-Guyler, King, Montieth, 2008). There remains, however, less information regarding interpersonal perceptions, environmental dynamics, and attitudes relevant to utilization of healthcare (Rojas-Guyler, King, Montieth, 2008; Aguirre-Molina, Molina and Zambrana, 2001). Understanding the perceptions of Latinos and the barriers to healthcare could directly affect healthcare delivery. Improved healthcare utilization among Latinos could reduce the long term health consequences of many preventable and manageable diseases. This study explored Latino perceptions of US healthcare and desired changes by Latinos in the US healthcare system. Objectives included exploring perceived barriers to healthcare utilization and the resulting effects on Latino health, describing culturally influenced attitudes about healthcare, and making recommendations for reducing disparities through improving healthcare utilization.

Methods: Qualitative methods were used to conduct a secondary analysis of four Spanish-language focus group transcripts to interpret cultural influences on perceptions and beliefs among Latinos. Direct coding of transcript content was carried out by reviewers, who conducted independent reviews of each transcript. Team members developed and decided thematic categories, positive and negative cases, and example text segments for each theme and sub-theme. Incongruities of interpretations were resolved through extensive discussion.

Results: Study participants included 43 self-identified male (16) and female (27) Latino adults. Thirty seven (84.1%) of the participants were immigrants. The participants comprised eight ethnic subgroups, and only 18.4% had medical insurance Five major themes regarding healthcare emerged during the analysis: (1) healthcare utilization, including experience and access; (2) communication and interpersonal interactions between providers, staff, and patients; (3) Latinos' perception of their own health status; (4) organizational and institutional systems; and (5) cultural influences on healthcare utilization, which included an innovation called culturally-bound locus of control. Healthcare utilization was directly influenced by past experience, access issues, health status, and cultural factors, and was indirectly influenced by organizational systems. There was a strong interdependence among the main themes. The ability to communicate and interact effectively with healthcare providers and navigate healthcare systems (organizational and institutional access) significantly influenced the participant's healthcare experience, most often (indirectly) impacting utilization negatively.

Implications: These data suggest that to improve healthcare utilization among Latinos, healthcare systems must create more culturally competent environments that include better language services and more effective providers at the interpersonal level. Better understanding of the complex interactions between these impediments can aid intervention developments, and help health providers and researchers in determining appropriate, adequate, and effective measurers of care to better increase overall health of Latinos.